Microsporidial Keratoconjunctivitis in the Tropics: A Case Series

Abstract

Purpose:To present a series of microsporidial keratoconjunctivitis in 24 eyes.Methods:Retrospective non-comparative observational case series. Medical records were retrieved and individuals evaluated based on symptoms, risk factors, visual acuity, slit lamp biomicroscopy and pathological examination of cornea epithelial scrapings. Demographic features, clinical course, predisposing factors, microbiological profile, treatment, final clinical outcome and visual acuity were recorded.Results:Of the 22 patients, 90.9% were men, with a mean age of 30.3 years (range 15 – 76 years). Two (9.1%) had bilateral involvement, 15 (68.2%) were non-contact lens users, 17 (77.3%) reported contamination with mud within 2 weeks (mean 6.8 days) of onset of symptoms. All patients presented with conjunctivitis and coarse, multifocal, punctate epithelial keratitis. Two out of 24 eyes (8.3%) had anterior stromal infiltrates, while 8 (33.3%) had anterior uveitis. Microsporidial spores were identified on modified trichrome staining of corneal epithelial scrapes in all eyes. All eyes were treated with epithelial debridement, topical fluoroquinolone and hexamidine diisethionate, 7 (31.8%) patients received oral albendazole, and all eyes with anterior uveitis received topical steroids. All cases resolved without visually significant sequelae.Conclusion:Microsporidial keratoconjunctivitis occurred mainly in males, is usually unilateral, presents as conjunctivitis and coarse, multifocal, punctate epithelial keratitis, and may incite anterior uveitis. Soil contamination is an important risk factor. Treatment with debridement, fluoroquinolones, hexamidine diisethionate with or without systemic albendazole is effective, with steroids reserved for any associated anterior uveitis.

Bilateral microsporidial keratoconjunctivitis in a clinically healthy female receiving intravitreal steroid injections: Associations and potential risk factors

“… 1 , 2 , 3 The great preponderance of immunocompetent MSK patients are male, outnumbering females 8:1 in one study. 10 Cases commonly present in the fourth decade, 1 , 9 , 10 and tend to be unilateral, 2 , 9 , 14 while our patient was in her 8th decade, and had bilateral infection. Because the patient demographic was slightly atypical, symptoms were mild, and findings resembled other more common conditions, MSK in our patient was not initially suspected.…”

“… 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 Microsporidial keratitis (MSK), however, is now also considered an “emerging” infection in immunocompetent individuals, being frequently associated with ocular trauma, exposure to soil or contaminated water, contact lens wear, and use of topical corticosteroids. 1 , 2 , 5 , 6 , 8 , 9 , 10 , 11 , 12 , 13 , 14 In this report we present a unique case of bilateral microsporidial keratoconjunctivitis (MSKC), in a uveitic patient receiving intravitreal steroid injections, with discussion of potential associations and risk factors.…”

Ocular Microsporidiosis—Our Experience in a Tertiary Care Centre in North India

“…Earlier interest in these pathogens was due to their being opportunistic pathogens in immunocompromised patients and ocular involvement in the form of keratoconjunctivitis was also reported in these patients [5]. Recent reports in literature have been more often in immunocompetent individuals [6] [7]. The ocular manifestations include superficial punctate keratoconjunctivitis, and corneal stromal keratitis.…”

Microsporidial Keratoconjunctivitis Outbreak among Athletes from Hong Kong Who Visited Singapore, 2012

“…An increasing incidence of microsporidial keratitis in Singapore that is strongly correlated with exposure to soil was reported during 2004–2007 ( 2 ). In a case series of 22 patients during 2006–2008 in Singapore, soil or mud were reported as predominant ocular contaminants that were contacted by athletes during sporting activities, such as playing rugby in muddy fields ( 3 ). …”

“…Time from soil exposure to development of ocular symptoms of microsporidial keratitis has been reported to be 2–21 days (median 14 days) ( 2 ) and 5–14 days (mean 6.8 days) ( 3 ). The incubation period during this outbreak was 5–31 days (median 15 days).…”